<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">


    <div class="form-group">
        <label for="c-province" class="control-label col-xs-12 col-sm-2">{:__('Province')}:</label>
        <div class="col-xs-12 col-sm-8" data-toggle="cxselect" data-url="/assets/libs/jquery-cxselect/js/cityData.min.json" data-selects="province,city,district" data-json-space="" data-json-name="n" data-json-value="">
            <select class="province form-control" name="row[province]" data-first-title="选择省" style="width: 70px;">
                <option value="">请选择</option>
                <option value="{$row.province2}" selected="">{$row.province}</option>
            </select>
            <select class="city form-control"  name="row[city]"  data-first-title="选择市" style="width: 70px;">
                <option value="">请选择</option>
                <option value="{$row.city2}" selected="">{$row.city}</option>
            </select>
            <select class="district form-control"  name="row[district]"  data-first-title="选择市" style="width: 70px;">
                <option value="">请选择</option>
                <option value="{$row.district2}" selected="">{$row.district}</option>
            </select>
        </div>
    </div>

    <div class="form-group">
        <label for="c-address" class="control-label col-xs-12 col-sm-2">{:__('Address')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-address" data-rule="required" class="form-control" name="row[address]" type="text" value="{$row.address}">
        </div>
    </div>
    <div class="form-group">
        <label for="c-consignee" class="control-label col-xs-12 col-sm-2">{:__('Consignee')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-consignee" data-rule="required" class="form-control" name="row[consignee]" type="text" value="{$row.consignee}">
        </div>
    </div>
    <div class="form-group">
        <label for="c-mobile" class="control-label col-xs-12 col-sm-2">{:__('Mobile')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-mobile" data-rule="required" class="form-control" name="row[mobile]" type="text" value="{$row.mobile}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
